The Generative Dynamics of Proactive Health: An Ecological Framework and an Adaptive Implementation Pathway

Abstract

Proactive health has gained prominence in China as a health-centred response to systems organised around episodes of illness, but existing accounts are stronger at listing attributes than at explaining how sustained action and health value are generated. This review develops a middle-range conceptual framework through a problem-driven synthesis of direct proactive-health scholarship and selected theories and international frameworks addressing health capability, salutogenesis, behaviour change, socioecological conditions, self-care, people-centred services, co-production, population health management, life-course health, implementation and performance assessment. We propose that proactive health is an ecologically generated and adaptively renewed process. Personal and collective health agency, supported where needed, must be coupled with real opportunities that are embedded in relationships, settings, services, information, technologies, resources and governance. The fit between them creates actionability: the practical possibility of taking a meaningful, feasible and supported next step. Actionability enables adaptive, co-produced action, which generates layered health value ranging from agency and protective resources to health capacities, functioning, well-being, participation, healthy longevity and public value. A personal learning loop revises goals and support in the light of lived experience, while a population learning loop draws on patterns of reach, benefit, burden and inequity to redesign the enabling ecology. A linked implementation pathway translates these relations into a life-course-sensitive sequence of sensing, assessment, goal setting, preparation, action, monitoring and adaptation. The framework distinguishes proactive health from risk prediction or individual responsibility alone, and offers a basis for intervention design, modular measurement and empirical testing, treating equity, rights and accountable governance as constitutive safeguards.

Keywords

proactive health / health agency / actionability / ecological framework / co-production / life-course approach / adaptive implementation / health value

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The Author(s). Published by Higher Education Press.

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